Most varicose vein problems arise when the valves in leg veins aren’t working to keep the blood moving out of the legs normally. When that happens, more blood pools in the veins under higher pressure than the veins are designed to handle. This is referred to as Venous Hypertension. The longer someone with these problems has their feet dependent, the more blood pools in their veins and the higher the pressure there becomes. This leads to the typical symptoms of aching, heaviness, fatigue, and throbbing associated with venous disease. It also leads to swelling in the legs and ankles as fluid starts to leak through the vein wall and accumulates in the soft tissues of the legs.

These symptoms typically are mildest first thing in the morning after the legs have been up, and get progressively worse throughout the day as the legs are down. The symptoms may be relieved by elevating the legs, wearing compression stockings to provide support, walking or taking pain medications.

Over time, the increased pressure in the vein leads to inflammation of the vein wall. This can cause itching over the affected varicose veins. It also can cause damage to the tissues surrounding the areas of highest pressure — a condition called Chronic Venous Insufficiency. This is seen as discoloration, thickening, and hardening of the skin and soft tissues in the lower legs. In the worst cases, this leads to sores or ulcers developing near the ankle. Correcting the underlying cause of the increased pressure in these veins is the best way to get relief.

When blood is pooling rather than circulating normally — especially in the presence of inflammation — there is increased risk of developing a blood clot. When this occurs in the deep veins (Deep Vein Thrombosis -DVT), it can be a severe, potentially life-threatening problem and requires prompt treatment with blood thinners and, sometimes, urgent procedures to extract the clot. There is a risk of this type of clot breaking off and travelling to the lungs (pulmonary embolism). When a clot forms in a superficial vein (Superficial Thrombophlebitis – STP) it causes sudden firm, painful swelling of the affected vein, often with redness or discoloration of the skin in the area. Up to 1/3 of STP cases are also associated with DVT, so an ultrasound is recommended to rule out the more serious type of clot. STP is treated with anti-inflammatory pain medications, compression, and ice. The symptoms usually resolve within a month with these measures.